Caring for Child w/ Resp. Condition Flashcards by Jess St John

-Narrow airway
-Nonproductive cough & little mucous
-Belly breathers til age 6
-Lymphoid tissues absent til age 7
-Epiglottis is long & flaccid til age 8
-Epiglottis is U-shaped
-Larynx & glottis is higher in the neck
-Thyroid/cricoid/tracheal cartilage are immature
-Neck has fewer muscles

Infant

How well did you know this?

Not at all

Perfectly

-Rapid growth and expansion of alveoli
-Lung development complete by age 5/6
-Right bronchus shorter, wider, and more vertical
-Frontal and sphenoidal sinuses are developed

Toddler & school-age

How well did you know this?

Not at all

Perfectly

What is the purpose of the eustachian tube?

-Reduces pressure
-Drains fluid from middle ear

More difficult to do these things in children because of shape (more horizontal than in adults)

How well did you know this?

Not at all

Perfectly

Health history information to obtain during assessment

-allergies
-immunizations utd?
-number of colds/year (6-8 is typical)

How well did you know this?

Not at all

Perfectly

Risk factors for respiratory distress

-congenital heart defects
-immunosuppression
-premature birth
-genetic disorders
-environmental (smokers, exposure to illness, daycare)

How well did you know this?

Not at all

Perfectly

Health O2 saturation for healthy infants and children?

95-100%

How well did you know this?

Not at all

Perfectly

Levels of resp. distress

mild, moderate, & severe

How well did you know this?

Not at all

Perfectly

Sx of mild resp. distress

-tachypnea
-tachycardia
-diaphoresis

How well did you know this?

Not at all

Perfectly

Sx of moderate resp. distress

-nasal flaring
-retractions
-grunting
-wheezing
-anxiety, irritability, & mood changes
-headaches
-hypertension

will still see mild sx

How well did you know this?

Not at all

Perfectly

Sx of severe resp. distress

-bradycardia
-stupor, coma
-cyanosis
-apnea/ALTE

will still see mild and moderate sx

How well did you know this?

Not at all

Perfectly

Mild retractions

intercostal

How well did you know this?

Not at all

Perfectly

Moderate retractions

substernal and subcostal

How well did you know this?

Not at all

Perfectly

Severe retractions

supraclavicular and suprasternal

How well did you know this?

Not at all

Perfectly

Irregular breathing with pauses <20 seconds

Normal resp. variation

How well did you know this?

Not at all

Perfectly

-Pauses lasting >20 seconds
-Associated with cyanosis, pallor, hypotonia, and bradycardia
-May be 1st major sign of distress in newborn

apnea

How well did you know this?

Not at all

Perfectly

-Color change, limp tone, choking/gagging
-Usually seen in infants under 2 months

ALTE (acute life threatening event)

How well did you know this?

Not at all

Perfectly

Causes of apnea/ALTE

reflux, lower airway disorders, seizures, trauma, sepsis, or pertussis

How well did you know this?

Not at all

Perfectly

Management of apena/ALTE

physical stimulation, resuscitation, and treating underlying cause

How well did you know this?

Not at all

Perfectly

Airway positioning for resp. distress

-avoid flexion
-do not hyperextend neck
-support shoulders w/ towel (sniffing position)
-upright position/elevate HOB

How well did you know this?

Not at all

Perfectly

Types of O2 tools

-nasal cannulas
-face mask
-blow by
-humidification
-bi-pap
-mechanical ventilation

How well did you know this?

Not at all

Perfectly

Malformation of the posterior choanae in the nose causing a blockage
-can be bone or membranous
-can be both sides or unilateral

choanal atresia

How well did you know this?

Not at all

Perfectly

S/sx of choanal atresia

Dyspnea
Cyanosis at rest
Difficulty eating (Choking, regurgitating food)
Unilateral choanal atresia may be asymptomatic unless child is sick

How well did you know this?

Not at all

Perfectly

How is choanal atresia diagnosed and treated?

Confirmed w/ CT

Surgical correction- transnasal or transpalatal w/ puncture or stenting

Bilateral requires emergency surgery

How well did you know this?

Not at all

Perfectly

Failure of esophagus to develop continuous passage to stomach
* Blind pouch

Esophageal Atresia (AE)

How well did you know this?

Not at all

Perfectly

Portion of esophagus is connected to the trachea by a fistula causing abnormal communication between the two structures

Tracheoesophogeal Fistula (TEF)

S/sx of AE & TEF

* Excess drooling/secretions * Frothing/bubbling * Cyanosis * Choking with feeding * Inability to pass OG/NGT

How is AE & TEF diagnosed and treated?

Confirmed w/ prenatal ultrasound (no barium) Surgical emergency to close fistula and join sections If preemie/compromised surgery will wait until stable

Barium can cause

defects and malformations

Autosomal recessive abnormality on chromosome 7 that impairs movement of Cl- and Na+ within the cells, thickening secretions. Most commonly the respiratory biliary, pancreatic, and intestinal tracts. Diagnosed using sweat chloride test.

Cystic fibrosis (CF)

What is the sweat chloride test: gold standard?

A mild electrical current pushes medicine into the skin causing sweating. Sweat is collected and salt content is measured. Normal <40mEg/L Suspicious 50-60mEg/L Diagnostic >60mEg/L

Systems affected by CF

Sinuses: sinusitis (infection) Lungs: thick, sticky mucous buildup, bacterial infection, and widened airways Skin: sweat glands produce salty sweat Liver: blocked biliary ducts Pancreas: blocked pancreatic ducts Intestines: cannot fully absorb nutrients Reproductive organs: male & female complications

Airway w/ CF

-thick, sticky mucus blocks airway -widened airway -blood in mucus -bacterial infection

Most common cause of death for CF pts?

lung damage is the most common cause of death

How to treat CF lung complications? * Mucous plugs cause air trapping and atelectasis * Chronic bacterial and fungal colonization progressively destroy lung tissue * Lung damage most common cause of death

-Airway clearance: chest physiotherapy and vests -“Asthma” Medications + Pulmozyme (thins secretions) -Yearly Tune-ups at the hospital -Minimize exposure to illness -CF patients should be separated by at least 6 feet from others with CF -Exercise/Fitness

How to treat CF digestion complications? * Clogging of pancreas ducts prevents pancreas from delivering digestive enzymes * Malabsorption-especially fats and proteins (steatorrhea) * Bowel obstruction due to thick mucous

* Pancreatic Enzymes with meals/snacks * 110%-150% Calories with 35%-40% fat intake (increase calories and decrease fat) * ADEK vitamins

How to treat CF skin complications? * Sweat gland malfunction leads to excess sodium & chloride in sweat

Salt tablets-may need during summer/exercise

How to treat CF reproductive system complications? * Small stature * Delayed puberty * Vas deferens in males affected 95% of males are infertile * Dense vaginal and uterine mucus plugs may block sperm from being able to fertilize an egg (fertility issues)

* Genetic counseling * Promote nutrition to encourage growth and development

Sore throat Commonly caused by: Viral 85% -Commonly Adenovirus Bacterial 15-25% Group A beta-hemolytic strep (GABHS)~15-25%

pharyngitis

S/sx of pharyngitis

Fever Sore throat Difficulty swallowing Cervical adenopathy Inflamed pharynx and tonsils Abdominal pain

Important points of pt education for pharyngitis

Take antibiotics as prescribed! (for bacterial) Tylenol/Ibuprofen Change toothbrush to prevent re-infection Return to school after 24 hours of antibiotics

What happens if antibiotics aren't finished?

Bacteria will become resistant to antibiotic

Tonsils secrete immunoglobins. Strep is most common cause.

tonsillitis

* Can be viral OR bacterial * Upper airway inflammation/swelling * Affects larynx, trachea, and bronchi * Edema/erythema of lateral walls of trachea below vocal cords

croup syndromes

* Viral etiology * Peak 3-36 mos. * URI * Seal-bark cough, worse at night

Acute Laryngotracheitis

* Viral etiology * Peak 3-36 mos. * NO URI * Sudden onset at night with barky cough

Spasmodic Croup

* Viral etiology * More common older children * Hoarseness

Laryngitis

Management of viral Croup

* Supportive care Fluids, Pain management, Fever management, Cool mist vaporize, & Steroids * Can usually manage at home

Types of bacterial croup

bacterial tracheitis, epiglottis, & laryngotracheobronchitis

* Progressive illness over 2-5 days * Complication of viral disease or prior URI * Can lead to life-threatening airway obstruction * High Fever >102.2 * Croupy cough * Thick, purulent secretions * Hoarseness

Bacterial Croup

* MOST Life-threatening * droplet precautions * Bacterial: H. Influenza, GABHS * Peak 1-5y * Rapid progression * High Fever 101.8-104 * 4 D’s: Dysphonia, Dysphagia, Drooling, Distressed Resp Effort * TRIPOD position * Lateral neck x-ray will show a narrowed airway/round epiglottis- ”Thumb sign”

Epiglottis

* Bacterial: Staph A (can be viral too) * Peak 3-36 mos. * Acute onset * High Fever 102.2 * Barky-seal cough * Hoarseness * Stridor and resp. distress * Chest x-ray will show a ”Steeple Sign”

Laryngotracheobronchitis

Why should throat inspections/cultures be avoided in pts w/ epiglottis?

can cause spasms

* Direct contact w/secretions or contaminated surfaces * Annual epidemics October-March Low grade-Moderate Temp URI/cough May be dehydrated Severe resp. distress Adventitious lung sounds Usually resolves 5-7 days

BRONCHIOLITIS/RSV (Resp. Syncytial Virus)

Infection of the pulmonary parenchyma (alveoli) * Retractions, nasal flaring, malaise, chest pain, poor appetite, adventitious or diminished sounds, abdominal distention & pain * Viral: Usually symptoms less severe * Bacterial: cough, dyspnea, tachypnea, adventitious breath sounds, grunting, retractions, toxic appearance * Mycoplasma: Common in pts with asthma

Pneumonia

* Highly contagious lung infection caused Bordatella Pertussis * Can be DEADLY to infants * Highest risk < 3 months * Signs and symptoms based on 3 stages

PERTUSSIS (WHOOPING COUGH)

Stages and sx of Pertussis

1. Catarrhal Stage- Lasts 1-2 weeks: URI-Mild cough, coryza, and sneezing, low-grade fever < 101°F 2. Paroxysmal Stage- Lasts 2-4 weeks: paroxysmal cough ending w/inspiratory whoop, 3. Convalescent StageLasts 3 weeks-6 months: Cough less severe-whoops slowly disappear.

Caused by any damage to the lungs- sepsis, viral pneumonia, smoke inhalation, drowning, or aspiration

Acute Respiratory Distress Syndrome (ARDS)

How to prevent VAP (ventilator acquired pneumonia)

-Prevention bundle care if ventilated which includes mouth care, suctioning, HOB elevated, not dumping condensation into ventilator circuit

Lung/bronchiole inflammation caused by a trigger that activates IgE antibodies * Causes the airway to swell and mucus trapping

Asthma

Asthma triggers

* Environmental * Viral illnesses * Allergens * BPD (bronchopulmonary dysplasia) * Misc: fragrances, exercise, emotions, weather changes

Severe s/sx of foreign body aspiration

cyanosis, drooling, dyspnea, forceful coughing, stridor, wheezing

Blockage of the respiratory passage with either fluid or solid matter Most common in toddlers Severity depends on size of object and angle of placement inside the passage

Foreign body aspiration

Smoke inhalation requires (Inhalation of smoke that is a mixture of gas and aerosolized matter)

emergency treatment that consists of stabilizing the airway and flushing excess CO2